Provider Demographics
NPI:1447427885
Name:SONOMA DENTAL GROUP, P.C.
Entity Type:Organization
Organization Name:SONOMA DENTAL GROUP, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:NAHAL
Authorized Official - Middle Name:
Authorized Official - Last Name:MAZHARI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:810-629-7682
Mailing Address - Street 1:234 W CAROLINE ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-2807
Mailing Address - Country:US
Mailing Address - Phone:810-629-7682
Mailing Address - Fax:810-629-0158
Practice Address - Street 1:234 W CAROLINE ST
Practice Address - Street 2:SUITE 5
Practice Address - City:FENTON
Practice Address - State:MI
Practice Address - Zip Code:48430-2807
Practice Address - Country:US
Practice Address - Phone:810-629-7682
Practice Address - Fax:810-629-0158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901017343261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental